Feng Mao

Original Article Prognostic value of the systemic immune-inflammation index in recurrent/metastatic triple-negative breast cancer: a retrospective cohort study Jialin Zhao, Xing Chen, Zijuan Zhang, Dachun Zhao, Xi Cao, Feng Mao, Qiang Sun, Li Peng

Letter to the Editor A balanced view of imaging and molecular markers for predicting axillary lymph node metastasis in T1 breast cancer Jialin Zhao, Xing Chen, Zijuan Zhang, Feng Mao, Li Peng

Background: Breast cancer has become a critical international healthcare issue. Specifically, among the different subtypes, breast cancer marked by human epidermal growth factor receptor 2 (HER2)-overexpression usually correlates with low survival and a poor prognosis and poses challenges in treatment, thus leading to high mortality. Case Description: A 54-year-old female patient was diagnosed with a large T4cN2aM0 stage IIIB breast tumor with HER2 overexpression. The tumor size was large, and there was a lack of opportunity for surgery. However, after neoadjuvant chemotherapy (NACT), the size of the tumor continuously shrank, and the patient successfully underwent a modified radical mastectomy. Even though a certain amount of mass remained and she did not complete six courses of NACT, our patient’s postoperative pathological result still revealed that a pathological complete response (pCR) was achieved. The appropriate time window for choosing surgical intervention should be determined based on the patient’s general condition instead of complying with the treatment guidelines. Also, imaging findings may be misleading in patients who have undergone NACT. Moreover, the regimen should be chosen flexibly. Conclusions: Patients with locally advanced breast cancer can still achieve a radical surgical resection following appropriate comprehensive treatment. Hopefully, this case can provide new ideas for surgeons when they face similar conditions.

Background: The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. Objective: This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. Methods: Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients’ medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. Results: A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01–1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). Conclusions: The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer.

This study aimed to determine whether there is an association between mammographic casting-type calcification and other prognostic factors for invasive breast cancer. We also assessed whether casting-type calcification could be an independent prognostic factor. Invasive breast cancer patient information from January 2010 and January 2013 was retrospectively reviewed. The associations between mammographic casting-type calcification and other clinicopathological factors, including tumor size, node status, grade, progesterone receptor (PR) status, estrogen receptor (ER) status, and human epidermal growth factor receptor 2 (HER2) status, were analyzed. The Kaplan–Meier method and a Cox proportional hazards model were used for survival analyses of disease-free survival (DFS) and overall survival (OS). A total of 1155 invasive breast cancer patients who underwent definitive surgery were included, and 136 cases (11.8%) had casting-type calcification on mammography. In multivariate logistic regression, casting-type calcification was significantly associated with axillary node metastasis, ER-negativity, and HER2 overexpression. Casting-type calcification significantly decreased OS and DFS after a median follow-up of 60 months. This result remained after adjusting other prognostic factors in the multivariate analysis. Casting-type calcification is significantly linked to axillary node metastasis, ER-negativity and HER2 overexpression. Casting-type calcification is therefore an independent prognostic factor for breast cancer patients.

Background: Milestone studies showed that ultrasound (US) was an effective primary screening test for breast cancer both in the western world and in China [PMID: 26712110, 26715161, and 25668012]. Ultrasound has been officially designated to be the initial imaging test for breast cancer screening in Beijing and several other cities in China, due to its improved sensitivity in Chinese women who usually have denser breasts and develop breast cancer earlier than Caucasian counterparts. Study showed that it would take 40 years to screen each woman in the target age group once [PMID: 26808342].The mainstay modality of breast cancer screening in China is the hospital-based opportunistic screening among asymptomatic self-referred women. However, there is little data about the tumor biology and long-term survival of the US-detected non-palpable breast cancer (NPBC) in hospital-based Chinese population. Methods: From January 2001 to December 2014, 3,786 asymptomatic women with positive (BI-RADS 4 and 5) initial screening US underwent biopsies in Peking Union Medical College Hospital, and 572 NPBC in 556 women were diagnosed. Women without dense breasts (defined as BI-RADS category C and D) also received screening mammography (MG) after physical examination and ultrasound. 788 patients with positive (BI-RADS 4 and 5) mammogram (MG) and normal US (BI-RADS 1, 2 and 3) underwent MG-guided biopsies and another 127 NPBC were diagnosed in 126 women. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) were reviewed and compared between the US-detected and MG-detected NPBC. Prognostic factors of NPBC were identified. Results: Overall, US could detect more invasive NPBC (83.4% vs 54.3%, pConclusion: Compared to MG, US detected more invasive NPBC with positive lymph node in hospital-based asymptomatic self-referred Chinese women, who could achieve comparable 10-year DFS and OS as MG-detected NPBC. US could serve as the feasible initial imaging modality in hospital-based opportunistic screening Chinese women. Citation Format: Yao R, Pan B, Zhu Q, Xu Q, Zhou Y, Zhang J, Mao F, You S, Lin Y, Shi J, Guan J, Wang X, Zhang Y, Zhang X, Shen S, Zhong Y, Xu Y, Liang Z, Jiang Y, Sun Q. Biology and long-term prognosis of screening detected non-palpable breast cancer by ultrasound in hospital-based Chinese population (2001-2014) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-02-05.